First job in Psych nursing

Hello - I am soon to be a Graduate Nurse in December (2 yr ADN program.) I'll be taking my NCLEX sometime in Jan. I'm very interested in Mental Health nursing and may have an opportunity to work at a local rehab/detox/addictions center. Is this a good place to get started in mental health nursing? They've already told me upfront the salary isn't competitive with MEd/Surg etc., but my biggest concern is limiting my abilities in the bigger realm of Psychiatric Nursing by starting out in such a specialized area. I have a bachelor's degree in Psychology and want to eventually get my MSN in Psych Nursing. Any advise?

I would say any opportunity right now is a good opportunity (considering the state of job market at the moment). Maybe, you could work at this job while looking for a hospital job? Any experience is valuable for new grads.

PS: My current pay at a psych hospital is higher than all of my friends in other specialties (DOU, M/S, ER) by the way.

Nov 28, '11

I would like to know what a day in the life of a pysch nurse is like - in my head (please don't be mad) I see them only passing meds and doing paperwork, plus occasionally tackling an agitated patient with an injection of haldol. During my pysch rotation, that is all that I ever saw the nurse do. Please set me straight, because I wonder if I would like it and I have the opportunity to cross train at my hospital. . .

Nov 28, '11

at my hospital the RN rarely does med pass, thats more of an LPN function. The RN does do a good bit of charting and paperwork. Initial assessments and discharges are RN jobs as well. I actually spend most of my time talking to my patients, trying to make our conversations as purposeful as possible, and trying to build strong therapeutic relationships.

Nov 28, '11

At my place, the med nurse passes the medications, educates the patients about the medications, hopefully convinces the paranoid patient to take their medication, does all the detox assessments and medicates accordingly.
The mileu nurse does vital signs, any treatments needed, watches out for the patients, talks to them, asses their mental status, encourages them to do their ADL's.
The charge nurse, is in charge of the floor, the MHW's, makes sure information in communicated to the staff and doctors. And a multitude of other things that are too many to name.
And all three of us RN's have paper work up the wazoo.
We don't tackle agitated patients, we are constantly assessing the agitated patient to make sure we do not have to put hands on.
Not to mentions the many discharges and admissions.
I don't think one could capture "a day in the life of a psych nurse" too much happens

I would like to know what a day in the life of a pysch nurse is like - in my head (please don't be mad) I see them only passing meds and doing paperwork, plus occasionally tackling an agitated patient with an injection of haldol. During my pysch rotation, that is all that I ever saw the nurse do. Please set me straight, because I wonder if I would like it and I have the opportunity to cross train at my hospital. . .

Not mad at all that you asked

Keep in mind that as a student you are there for a 6-8 hour snippet of time, most of which is probably spent conferring with your instructor (pre-clinical, post-clinical, etc.). So you don't have the chance to see patients improve day-by-day...and that's one thing you need to get used to in psych. It's not like med-surg where you administer the metoprolol and watch the patient's critically high BP go down in minutes. Improvements in psych patients aren't as automatic...or always as visually manifested.

Also keep in mind that you may have caught the unit on a "good day" where the patients are stable...good for the patients and the staff, but bad for eager nursing students who want to see full-blown psychiatric conditions at their finest.

Paperwork is a lot of the job, but that's how it is in any nursing specialty.

Medications is a big part of the job--it's one of the primary nursing interventions. And you need to be on top of your medication knowledge because of the nature of psychotropics...and because you're still giving them their regular meds as well. Oh yeah, did I mention that we have to take care of patient's medical as well as psychiatric conditions? Because despite rumors to the contrary, when admitted, patients don't check their medical baggage at the door. We may not be inserting Foleys or playing with IV drips as much as the med-surg floor, but we have got physical as well as mental assessments to do and the issues of both to be addressed. And those physical issues can get very sticky if you throw substance addiction and detox into the mix, since some of those detoxes can be fatal.

Therapeutic communication is another primary nursing intervention. It's often hard for nurses to talk to the patients during the day shift, between doctors rolling through with orders and patients in groups all the time. But later on in the day when things slow down there's a lot of chances to talk with patients, lots of opportunities to find out how they're doing mentally and teach coping skills, med ed, aftercare planning, etc. In fact, a lot of nurses also run groups.

Despite the challenges of talking to patients on the day shift, we in psych probably see and interact with our patients more so than most other specialties. Psych facilities have minimum observation levels where we have to visually see each patient and what they are doing every 15-30 minutes. Come hell or high water, we have to observe them and see that they are safe. That doesn't mean we always only look at the patient and move on; often we'll exchange a few words with them, do a quick MSE if we have to...whatever it takes to make sure they're safe. Of course, more acute patients means increased observational frequency.

And contrary to belief, we don't rush to tackle, restrain and shoot them up with Haldol. In fact, our goal is to NOT to have to resort to those drastic measures if we can help it. So agitated or hallucinating patients get frequent assessing and reassessing; if we see things going south, we step in fast to deescalate the situation. We can be very creative in coming up with ways to help them deescalate when we have to--I've jogged up and down the hallway with a patient for 15 minutes once because that's the only way I could get through to her and find out what we could do to help her.

And often we can help the patient bring themselves under control without resorting to the drastic measures...again, a good thing for us and the patient, a bad thing for nursing students hoping to see some excitement.

The other posters are right: one day--or in a student's case, one small part of a day--is not enough to see what psych nursing is like. And no two days are ever the same.

As far as whether it would be a good fit for you...only you can decide that. If you can, try to shadow a psych nurse for a few days, or try a PRN job in psych. If you're not a nurse yet, try being a psych tech--that will get you on the floor and into the action.

I would like to know what a day in the life of a pysch nurse is like - in my head (please don't be mad) I see them only passing meds and doing paperwork, plus occasionally tackling an agitated patient with an injection of haldol. During my pysch rotation, that is all that I ever saw the nurse do. Please set me straight, because I wonder if I would like it and I have the opportunity to cross train at my hospital. . .

I could really change your point of view, so if interested pm me. It is so heartbreaking to read
your observations above..psych nursing is no easy specialty...

Keep in mind that as a student you are there for a 6-8 hour snippet of time, most of which is probably spent conferring with your instructor (pre-clinical, post-clinical, etc.). So you don't have the chance to see patients improve day-by-day...and that's one thing you need to get used to in psych. It's not like med-surg where you administer the metoprolol and watch the patient's critically high BP go down in minutes. Improvements in psych patients aren't as automatic...or always as visually manifested.

Also keep in mind that you may have caught the unit on a "good day" where the patients are stable...good for the patients and the staff, but bad for eager nursing students who want to see full-blown psychiatric conditions at their finest.

Paperwork is a lot of the job, but that's how it is in any nursing specialty.

Medications is a big part of the job--it's one of the primary nursing interventions. And you need to be on top of your medication knowledge because of the nature of psychotropics...and because you're still giving them their regular meds as well. Oh yeah, did I mention that we have to take care of patient's medical as well as psychiatric conditions? Because despite rumors to the contrary, when admitted, patients don't check their medical baggage at the door. We may not be inserting Foleys or playing with IV drips as much as the med-surg floor, but we have got physical as well as mental assessments to do and the issues of both to be addressed. And those physical issues can get very sticky if you throw substance addiction and detox into the mix, since some of those detoxes can be fatal.

Therapeutic communication is another primary nursing intervention. It's often hard for nurses to talk to the patients during the day shift, between doctors rolling through with orders and patients in groups all the time. But later on in the day when things slow down there's a lot of chances to talk with patients, lots of opportunities to find out how they're doing mentally and teach coping skills, med ed, aftercare planning, etc. In fact, a lot of nurses also run groups.

Despite the challenges of talking to patients on the day shift, we in psych probably see and interact with our patients more so than most other specialties. Psych facilities have minimum observation levels where we have to visually see each patient and what they are doing every 15-30 minutes. Come hell or high water, we have to observe them and see that they are safe. That doesn't mean we always only look at the patient and move on; often we'll exchange a few words with them, do a quick MSE if we have to...whatever it takes to make sure they're safe. Of course, more acute patients means increased observational frequency.

And contrary to belief, we don't rush to tackle, restrain and shoot them up with Haldol. In fact, our goal is to NOT to have to resort to those drastic measures if we can help it. So agitated or hallucinating patients get frequent assessing and reassessing; if we see things going south, we step in fast to deescalate the situation. We can be very creative in coming up with ways to help them deescalate when we have to--I've jogged up and down the hallway with a patient for 15 minutes once because that's the only way I could get through to her and find out what we could do to help her.

And often we can help the patient bring themselves under control without resorting to the drastic measures...again, a good thing for us and the patient, a bad thing for nursing students hoping to see some excitement.

The other posters are right: one day--or in a student's case, one small part of a day--is not enough to see what psych nursing is like. And no two days are ever the same.

As far as whether it would be a good fit for you...only you can decide that. If you can, try to shadow a psych nurse for a few days, or try a PRN job in psych. If you're not a nurse yet, try being a psych tech--that will get you on the floor and into the action.

I like that. I don't want to do a lot of (preferably any) procedures. I'm not interesting in IV's, Foleys, NGTs, etc. I used to work as a paramedic some (side job). I'm past skills. To me they're a hastle. I'd rather just talk to people and deal with paperwork, lol. My career has been in law enforcement. I've seen psych patients at their worst when there was no "control" or medication in their lives. I'm not fearful of them, and I've run the gamut from talking to them making them feel better and getting a handle on the situation to them trying to kill me and taking them to the hospital. I like psych. It's interesting and appeals to me. The only part of "the rest" of nursing that interests me is the physio and patho. I want to know "it", and as bad as it sounds I don't actually want to do "it" if that makes sense. I don't mind tending to medical matters, but it's not something I want my day to revolve around. I realize there are med-surg tasks to be done in psych, but it's not what the field centers around. I like that.

Dec 14, '11

Sounds like you are a natural for psych. given what you said. Your original post mentioned a first job at a rehab/addictions type place. I agree "any job is a good job" but know going in that in that kind of setting you might get discouraged by seeing some heavily Axis II, addictive personality types w. the associated games/drug-seeking behaviors. I enjoyed working in that area never-the-less as we had a great team. You can always move on to another area, having more skills under your belt from the experience!! Good luck to you!

Jan 7, '12

If you want to see what its like to be a psych nurse, try and Google some blogs written by some! It's always nice to see it from different points of view. Good luck!!